Current role of laparoscopic surgery for liver malignancies.

The use of laparoscopic surgery in managing liver malignancies has been developed only recently because of the complexity of liver surgery. Diagnostic laparoscopy is useful in staging liver malignancies before resection. The need for laparoscopic staging of colorectal liver metastasis has diminished as a result of better imaging technology such as positron emission tomography (PET). Laparoscopy still plays an important role in the staging of hepatocellular carcinoma because of the high incidences of multifocal tumors and venous invasion. Recently, laparoscopic liver resection was possible with the availability of new instruments that allow relatively bloodless liver transection. Small series have reported a conversion rate of 10% to 20%, and the complication rate and transfusion rate appeared to be comparable with open surgery in a few retrospective case-control studies. Limited data also suggest that oncological clearance and long-term outcome were not compromised. However, the role of laparoscopic liver resection is confined mainly to wedge or segmental resection of anterior segments of the right lobe and left lateral segments. Although successful laparoscopic hemihepatectomy and resections of segments VII and VIII have been reported at the time of this writing, these should be attempted only in centers that have already acquired wide experience with laparoscopic liver resection. Another application of laparoscopic surgery for the management of liver malignancies is laparoscopic radiofrequency ablation, which is gaining popularity because of its well-documented safety and efficacy. With further developments in technology, that laparoscopic surgery will have a greater impact on the management of liver malignancies is foreseeable in the near future.